Adolescent Acne: Association to Sex, Age, Pubertal Stage and Circulating Concentrations of Testosterone and DHT

Jakobsen Nanna E.; Holmboe Stine A.; Petersen Jørgen Holm; Lise Aksglaede; Hagen Casper P.; Busch Alexander S.; Johannsen Trine Holm; Hanne Frederiksen; Anders Juul

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ESPE Abstracts (2024) 98 FC3.6

ESPE2024 Free Communications Pituitary, Neuroendocrinology and Puberty 1 (6 abstracts)

Adolescent Acne: Association to Sex, Age, Pubertal Stage and Circulating Concentrations of Testosterone and DHT

Nanna E. Jakobsen ^1,2 , Stine A. Holmboe ^1,2 , Jørgen Holm Petersen ³ , Lise Aksglaede ^1,2 , Casper P. Hagen ^1,2 , Alexander S. Busch ^1,2 , Trine Holm Johannsen ^1,2 , Hanne Frederiksen ^1,2 & Anders Juul ^1,2,4

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¹Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. ²International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. ³Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark. ⁴Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Background: Presence of current acne is well described in adolescents and adults with altered sex steroid levels, e.g., in polycystic ovarian syndrome, androgen producing tumors and misuse of anabolic androgenic substances. However, less is known about the impact of physiological concentrations of testosterone and dihydrotestosterone (DHT) quantified by gold standard LC-MS/MS methodologies on the development of acne in healthy adolescent boys and girls.

Aim: To study the prevalence of acne in healthy children and adolescents according to sex, age, anthropometry, pubertal stage, and serum concentrations of testosterone and DHT quantified by LC-MS/MS.

Method: A combined cross-sectional and longitudinal population-based cohort study (ClinicalTrials. gov ID: NCT01411527) was used including 1,609 (58% girls) participants aged 5.6 to 23.4 years with presence of current acne recorded by trained physicians. Of these, 222 children and adolescents were part of a longitudinal study and were examined every six months for five years. Furthermore, a cross-sectional subpopulation of 1,009 children and adolescents (57% girls), where a serum sample was available, was included. Absolute values of body mass index (BMI) and serum concentrations of testosterone and DHT were sex- and age-corrected into relative standard deviation (SD) scores.

Results: The median age of occurrence of acne in boys was 15.0 years (95% CI: 14.7-15.3) based on probit analyses using left-, right-, and interval-censored data, whereas such statistical analyses could not be performed in girls due to insufficient number with acne. The presence of current acne in boys was observed in Tanner stages G4 (44%) and G5 (83%), respectively. In addition, presence of current acne was more prevalent in adolescent boys compared to girls in corresponding Tanner stages B4 (15%) and B5 (12%), respectively. In a multivariate logistic model, BMI SD scores were significantly higher in boys with acne compared to girls with acne (OR=1.3 (1.0-1.7), P = 0.04). Testosterone SD scores were significantly higher in boys with current acne (Median (IQR): 0.44 (-0.10;1.14)) compared to those without (-0.15 (-0.81;0.67), P <0.01. DHT SD-scores were significantly higher in adolescent boys (0.29 (-0.38;0.93) and girls (0.29 (-0.44;1.73)) with current acne compared to adolescents without, P <0.01.

Conclusion: Acne was recorded in 85% of late pubertal boys, and in 15% of late pubertal girls. Serum DHT SD-scores were significantly higher in adolescents of both sexes presenting with current acne.